Donald Trump and Republicans in Congress are determined to gut Medicaid and
undo the Affordable Care Act (ACA)’s major advances for women’s health in order to pass tax cuts for the very rich. The Senate’s version of Trumpcare is more bad news for women and our families.

A projected 22 million people—more than half of them women—would lose health insurance. 15 million people would lose their health insurance next year. The total would rise to 22 million by 2026. Millions more would lose it after 2026—all to give the wealthiest Americans a trillion dollar tax cut! That’s not a health care bill. It’s a tax cut bill.

Trumpcare would eliminate the Medicaid expansion and make drastic cuts to traditional Medicaid. The Senate bill would cut $772 billion from Medicaid, slashing its funding by more than a fourth and ending Medicaid’s long-standing guarantee of coverage for pregnant women, children, disabled people, seniors and more.

Drastic cuts to Medicaid would leave many older women and women with disabilities unable to afford long-term care. Because women live longer, we are more likely to need long-term care than men. But regular health insurance and Medicare do not cover long-term nursing home care, which can cost $82,000 per year, or in-home care. Today, Medicaid pays for half of all long-term care in the U.S. for both low-income and middle-income seniors. If Trumpcare’s Medicaid cuts become law, states will be forced to limit the care they pay for, drop people from coverage, or both.

Pap tests, contraception, STI screenings, and more would no longer be covered by Medicaid at Planned Parenthood. The Trumpcare bill would block Planned Parenthood from accepting Medicaid for one year, forcing clinics to close and reducing access to care for 1 million women and men.

Private coverage of abortion care could disappear. Trumpcare would ban the use of federal financial aid (premium tax credits) to buy private health plans that cover abortion. As a result, most plans would drop coverage. In states like NY and CA, which require abortion coverage, no one could use federal premium tax credits to buy private coverage.

Maternity coverage and other essential health benefits would cost much more for millions of women. The Senate’s Trumpcare bill would allow states to let insurance companies drop coverage of essential health benefits such as maternity care, hospitalization, prescription drugs and mental health services.
Women in a state that opts out could end up paying as much as $1,000 a month more in premiums to add maternity coverage. Although Senate GOP leaders claim protections for people with pre-existing conditions would be preserved in this bill, people with serious illness could have difficulty finding or affording health insurance that covers the care they need, in states that allow insurers to drop coverage for essential health benefits.

Older women would see skyrocketing prices for individual health insurance. The Senate’s Trumpcare bill would make people over 50 pay a LOT more. Many low and moderate income women would be unable to afford insurance. Under Trumpcare, the price of a basic health plan for a 64-year-old making $26,500 a year would quadruple from $1,700 to $6,500. A 64-year-old making $56,800 a year would face a premium of $20,500 a year. Who could afford to spend one-third of their income on health insurance?

People who lose insurance for more than two months following a job loss or change in relationship would face a six-month waiting period to get covered. This rule would do little to encourage healthy people to get covered but it would harshly punish anyone who loses coverage through no fault of her own. Six months could be the difference between life and death for a person with cancer waiting for treatment. It will be particularly cruel for women, who are less likely than men to have insurance in their own names.

Speak out against this proposal! Call Senators Baldwin and Johnson today!

In mid-May, WAWH was one of the many organizations that submitted comments to the Department of Health Services (DHS) in regards to the proposed changes to Wisconsin BadgerCare Program for Childless Adults in the form of a 1115 waiver.  This waiver included proposed changes such as:

• Requiring monthly premiums for a majority of childless adults enrolled in BadgerCare.
• Limiting eligibility by length of time
• Requiring substance abuse screening and testing for eligibility
• Referral to treatment programs where refusal to go would result in ineligibility

WAWH opposed their proposal as it overlooked women of childbearing age that do not have children, those with chronic conditions, and create an unhealthier Wisconsin as a whole.  

DHS received a total of 1,050 comments in regards to the changes proposed by Governor Scott Walker.  Only 5 out of 1,050 comments were in favor of these proposed changes. That means that 1,045 comments, or over 99.5% of those who shared their comments with DHS, were against the Governor’s plan.

DHS is still withholding the names of those that commented, but those that are known include religious leaders, non-profit organizations, doctors, students, and many other Wisconsinites. Of the 5 comments that positively regarded the proposed changes, the only two known supporters are government officials in Scott Walkers corner: Lieutenant Governor Rebecca Kleefisch and state Representative John Nygren.  Kleefisch and Nygren currently co-chair the governor’s task force on opioid abuse.

DHS released a “Summary of Public Comments and Wisconsin DHS Response” that listed the “changes” that were made due to the comments made, but also gave a brief summary of the comments in general.  Misleading statements such as, “Additionally, there were a number of other comments that were either wholly in opposition or approval of the proposed waiver amendment.”  It is a tough pill to swallow that DHS would make a statement that creates the illusion that this was a 50-50 issue.  It required an open records request to see the sheer number of negative comments in relation to the five positive ones.

It is clear that this plan did not take into account the view of the 1,045 comments made, because the changes that were made were essentially irrelevant to the concerns of every group that WAWH worked with and are as follows:

• Premium payments will still be added, but will be two tiered instead of four tiered to avoid confusion.  This still does not address the issue of even small premiums being detrimental to some individuals, leading to lower enrollment in BadgerCare.
• The emergency department copayment would be set at $8 a visit instead of being raised later on.  This is another example of a change that does not address the problem that any copayment can be so harmful that an individual may not go get medical attention when it is seriously needed.
• If a BadgerCare member refuses to consent to substance abuse disorder treatment, instead of being ineligible for six months, an individual may re-enroll whenever they consent to treatment.  This policy essentially forces an individual into treatment in order to receive medical coverage.
• A drug test will not be required for childless adults who indicate they are ready for treatment and you may opt to go to treatment even without a positive substance abuse test.

It is clear that the comments of the Wisconsin people were not taken seriously as the overwhelming majority of commenters’ opposed the changes that are being proposed.  While DHS made changes based on these comments, those changes do not take into account any of the negative effects that WAWH and numerous other organizations see as the harm to Wisconsin.  The waiver purports to increase enrollment in BadgerCare and create a healthier Wisconsin, when in reality it does the opposite.  These concerns have been completely ignored by DHS.

Link here to view the final version of the waiver application submitted to CMS on June 7th. 

In May WAWH submitted comments to the Wisconsin Department of Health Services (DHS) regarding the Department’s proposed changes to the BadgerCare program for low-income, “childless adults” who earn an income at or below the federal poverty level.  DHS is currently seeking a waiver from the federal government that would allow the Department to implement changes the program that would otherwise be prohibited by federal law that governs the Medicaid program. 

The proposed changes include:

1. Charge enrollees monthly premiums
2. Charge higher monthly premiums for enrollees engaged in "risky behavior" as indicated through a Health Risk Assessment
3. Impose lifetime eligibility limits for certain enrollees who do not satisfy work or work training requirements
4. Require drug screenings as a condition of eligibility and make referrals to treatment programs for those who test positive for drug use

If implemented, the Department’s proposed waivers would harm low-income adults currently participating in BadgerCare. These changes will actually undermine the Department’s stated goals of reducing the uninsured rate and increasing workforce participation, as many BadgerCare participants who rely on the program to access the health care they need to maintain employment will be thrown off the program as a result of these changes.  This plan will simply shift costs onto low-income people, which will lead to further cost-shifting in the form of uncompensated hospital care that will result from former BadgerCare enrollees having to turn to emergency rooms to treat conditions that could have been prevented with access to preventive care.  Finally, the Department’s approach will waste state funds that could be used to implement far more effective strategies for expanding the Wisconsin workforce and providing adequate resources for substance use disorder treatment.
 
Many other organizations that advocate for greater access to health care and on behalf of health care professionals have expressed similar concerns regarding the Department’s proposed waiver.  The widespread opposition to the proposed waiver is largely based on experiences in other states that have adopted similar policies and significant research that indicates such changes will reduce access to health care for many of the particularly vulnerable populations that would be affected by this proposal and likely have no other means through which they can access health insurance.

A copy of our waiver comments can be found here.

In 2010, the Department of Health Services (DHS) created the Healthiest Wisconsin 2020 plan with the input of over 1,500 people including staff of the Wisconsin Alliance for Women's Health.  The plan set out to create a healthier Wisconsin by addressing health, social, economic, educational, and environmental issues that contribute to health problems in Wisconsin.  This plan differed from previous plan because it not only focused on risk factors for death, but broadened the plan to include factors that contribute to quality of life. 

The newly released Wisconsin Health Improvement Plan (WI-HIPP) supplements the Healthiest Wisconsin 2020 plan with a narrowing of the focus of the DHS to five main factors.  These new priority factors are alcohol, nutrition and physical activity, opioids, suicide, and tobacco.  While we recognize that these are all important factors in keeping Wisconsin healthy, there are some key components missing from this Health “Improvement” Plan - components that matter greatly to the health and wellbeing of Wisconsin women and girls.

The WI-HIPP reverts back to the problem of only focusing on factors that lead to death by failing to include the following relevant health topics:

• Reproductive and Sexual Health
• Injury and Violence- specifically to women and children
• Mental Health-outside of the suicide and opioid context
• Policy initiatives to deal with disparities in general

These are just examples of health concerns left out of the new plan. 

Reproductive and sexual health deals with unintended pregnancies, teen births, sexually transmitted diseases, adolescents, and HIV/AIDS.  While these factors may not all lead to death, the physical, emotional, mental, and social well-being to a persons’ life under these circumstances are monumental.  Issues such as unintended pregnancies can also create bad birth outcomes while perpetuating disparity in Wisconsin.

Excluding injury and violence is another concern.  Specifically, violence against women and children such as sexual assault needs to be a higher priority.  It is estimated that 14% of Wisconsin women over the age of 18 has been raped in their lifetime.  This is an act that disproportionately affects women in Wisconsin, and it is also noted that two-thirds of victims of assaults are under the age of 15, so female children are who is being harmed by this issue not receiving priority status.

Outside of the context of what issues received priority focus, the WI-HIPP purports to explore these issues from the perspective of older adults, racial and ethnic minorities, poor, and the geographically diverse, but says nothing about other underrepresented populations such as women or those of a different sexual orientation or identification. 

While moving towards a more healthy Wisconsin is always a positive goal, we must be careful about how we go about reaching that goal.  Disparity is one of the biggest issues in Wisconsin, and focusing on the same physical factors that have always been a priority will only perpetuate a cycle in which disparity in Wisconsin continues to grow. 

Key missing components from the Emphasis of WI HIPP:

• Within disparities: WI HIPP mentions older adults, racial and ethnic minorities, economic status, and geographic disparities but hey neglect to include sexual identities and orientations, gender identities (specifically women), and educational status.
• Reproductive and Sexual Health and Education
• Injury and Violence- specifically to women and children
• Mental Health- outside of suicide and opioid context
• Oral Health
• Environmental Concerns
• Policies initiatives to reduce things like disparities, poverty, discrimination
• Policies that would improve education